Thursday, March 26, 2009

UK Fac HI Think Tank

Today I took another trip to London, this time for a UK Faulty of Health Informatics Think Tank at the Cass Business School, City University.Bev Ellis took on the unenviable task of trying to chair the day and she welcomed participants, including Faculty board members and Peter Knight from Connecting for Health and set out the aims for the day around sharing research. She highlighted the importance of the networks which the faculty provides and facilitates and highlighted why the work is particularly relevant now following the statement in the Darzi review of the NHS related to research and change management aspects.

“We will continue to transform health research in the NHS by implementing, consolidating and building on the Government’s strategy, Best Research for Best Health, for the benefit of patients and the public. Our researchers have made a great contribution and will continue to do so. However, too often innovation has been defined narrowly, focusing solely on research, when in fact innovation is a broader concept, encompassing clinical practice and service design. Service innovation means people at the frontline finding better ways of caring for patients – improving outcomes, experiences and safety. In this country, we have a proud record of invention, but we lag behind in systematic uptake even of our own inventions”

Professor the Lord Darzi of Denham KBE Hon FREng, FMedSci – High Quality Care for All – NHS Next Stage Review Final Report – July 2008

Bev argued that innovation is defined too narrowly and needed to widen this to take on board the importance of “what works”. The event’s main objectives are to:

1. To identify how existing Health Informatics research undertaken by students and NHS staff could be accessed, used and applied more effectively to further improve services.

2. To ensure that future research into the impact of technology and other good informatics practice in patient care can be stimulated in order to provide an improved evidence base to assess the value of Informatics in healthcare.

3. To ensure that concerns and obstacles over the effective and safe use of data for wider Health research are addressed and overcome.

The day centered around draft reports and presentations from 5 teams who had received faculty grants and will be making their full and final reports available next week.The first presentation was by Jean Roberts from UCLAN (Grant 5) whose position paper addressed “Working even more effectively with key stakeholders to better support existing HI R&D programmes and to facilitate improved access to UK and European funding sources of funding for HI related R&D”. Her work described the situation with research funders who have eclectic rules with no clear patterns. She shared some tricks and tools for research bid creation to get research funding from a range of sources – when the criteria can undergo sea changes, and are not always declared or consistent. Her analogy was scrabbling in the volatile mud to find them he nuggets and highlighted some of the tensions and benefits inherent in the research funding process. She suggested the faculty may have a role in the dissemination of calls etc and reflection afterwards whether successful or otherwise. Examples were given from the ESRC and others emphasising the need to show strategic & national significance and further exploration of the balance between pure scientific merit & health needs. The Q&A/discussion touched on applied v pure research, the different funders & procedures, Pre & post 1992 universities differences, HI bids submitted under various other banners and sustainability.The next speaker was Susan Clamp on behalf of a team, including Richard Jones and Mark Hawker from the Yorkshire Centre for Health Informatics, on their work “Overcoming barriers to the safe use of patient data for Research and Development between the NHS and Higher Education”. She set the context emphasising the information intensive nature of medicine and issues of change management and Evidence Based Medicine. She set out government commitments to make the NHS research based including the role of the Secondary Uses Service (information Centre) and the use of electronic records. The current picture with Cancer Registries databases and the similar incompatible and unconnected demographic sources, and separate data collection for trials was described as being very expensive. She also described current work by the National Institutes of Health Research (NIHR), various funders etc and the need for a rationale and streamlined process. The Electronic Health Record was seen as providing a solution to these problems.

Clinical trials & identifying participants – numerous databases but not connected. There was some mention of anonymisation & pseudanonmisation, confidentiality & security but these were not the focus of the work – but triggered the majority of the discussion. Comparisons were drawn with US and Danish cohort studies. She also argued that modules and other education for clinicians about demographic databases was needed. The projects recommendations were around educating and challenging executive leaders, middle-ranking research leaders and influencing grant forms and the like. This process was seen as needing to promote engagement suppliers. A case was made for system designers and HI staff in the NHS workforce to include research requirements aat early design stages. The debate which followed focussed on consent, confidentiality and privacy issues which are likely to figure in the current ministerial review on the use of identifiable data. Research which is informing this had found differences among different socio-economic groups in their attitudes to these issues.

I went next with a presentation of the work from a combined team between Bristol Children’s Hospital Paediatric Intensive Care Unit and the University of the West of England. We were funded to look at “Developing a culture of knowledge sharing across the NHS that stimulates the application of Health Informatics research and best practice.We were followed by Frits Janssen from ITW who gave a wide ranging presentation about eh importance of knowledge sharing, the importance of NHS Informatics in delivering patient care, the support NHS Health Informatics Services need in order to facilitate UK as a world class centre for R&D, a review of NPfIT and a discussion of who the stakeholders might be while shopping for £120,000 to fund a benefits realistaion program, based on work his organisation had done with the local government sector.The final of the 5 presentations was given by Howard Leicester (RCS Edinburgh) on the work he had undertaken with Abdul Roudsari on “improving access to, dissemination and the application of research undertaken by Health Informatics students at Masters Level in Higher Education across the United Kingdom”. He started with the best joke of the day about how if you say Health Informatician slowly it comes out as Health Info Morticians – and suggested we may be killing the stuff we are trying to gather & share. The focus of their work was on the case for a repository for knowledge sharing based on MSc research but covered wider aspects about the size of the pool for students. They had conducted a survey of students and few were getting their work published and suggested the repository as a way of sharing it as long as the work meets some quality standards. The Q&A session discussed whether this would be setting up another specific silo, quality review processes, and the role of specialist groups etc. Unfortunately I didn’t have time to talk about the system in Wales where Informing Healthcare second students onto the part time MSc in Health Informatics at Swansea University.The planned workshops were cancelled & turned into shorter mass debates with each team presenting one question for discussion amongst all the delegates present. This did produce a fairly wide ranging discussion however it felt a little messy with several individuals just stating again points which had been made in previous presentations and discussions with added Chasms & Tsunamis!

Concluding summaries were given by Bruce Elliot looking at the way forward for the faculty and Peter Knight who gave a connecting for health analysis of the need for health informatics skills over the next few years in the light of international competition and changes in healthcare delivery and the pharmaceutical industry changes. He also argued for the need for tangible case studies which will enthuse various stakeholders. He concluded that the work needed to continue to enhance capability and capacity in the NHS and academia.

The full reports from each of the projects will be published on espace next week and further information about the work arising from the day will be in a faculty bulletin early in April.

In general it was a useful networking day which aired a range of topical issues but if the intention was to reach a wider audience than the “usual suspects” it was probably quite limited.

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Eclectic news and views on health informatics and elearning, by Rod Ward & colleagues. UK bias but worldwide coverage.
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